Electronic Data Interchange, or EDI, is a way to send paper-based invoices as electronic documents. In addition to enhancing the payment process and providing automation for a labor-intensive process, EDI offers easy and inexpensive transmission of structured information.
IMPORTANT NOTE: On January 15, 2009, the U.S. Department of Health and Human Services (HHS) released a final rule that updated standards for electronic health care transactions. The rule adopts updated versions of the standards governing electronic transactions under the authority of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The updated electronic transaction standard is an implementation of ASC X12’s version 5010. View the HHS website for additional details.
EDI Providers currently submitting 4010 claims will be required to complete three (3) successful tests under the new format prior to going live. New EDI Providers will be required to complete nine (9) successful tests prior to going live.
EDI depends on an information technology infrastructure that includes data processing, data management and networking capabilities. The end result is that the capture of data into electronic form, the processing and retention of data, controlled access to it and efficient and reliable data transmission between remote sites requires little human intervention. A common connection point is needed for all participants, together with a set of electronic mailboxes (so that the organizations' computers are not interrupted by one another) and security and communications management features.
In use since the early 1970s, came to the forefront in the 1990s, with many large distribution companies and government organizations embracing the technology. EDI offers organizations better information flow, reduced costs and more accurate accounting. EDI also may save money because it can eliminate the overhead of printing and mailing paper documents. On the administration level, EDI can reduce or eliminate keypunching error, therefore providing additional savings.
The transmission of EDI documents is not as simple as transferring data files back and forth via a modem. EDI is based on a set of ANSI ASC X12 standards that are used for document content and structuring. Please review the informational links and documentation below for more information about EDI and how it works.
To participate in EDI, please review the documentation in the EDI Documentation and Information column and complete the EDI Trading Partner Agreement. Once complete, contact the EDI Coordinator to schedule your implementation.
Direct Data Entry (DDE) will replace the Data Entry Module (DEM) currently used by many PASSPORT providers to enter and submit PIMS invoices to PASSPORT Administrative Agencies. Unfortunately, DEM does not meet the requirements for HIPAA compliance. DDE operates similarly to the DEM but is Web-based.
We are offering this information on DDE for providers who want to use this billing functionality. Contact your Area Agency on Aging
if you are interested in using DDE.
The documents are in Adobe Portable Document Format and require Adobe's free Acrobat Reader or equivalent software to view. File sizes are given in parenthesis. Larger files may take a long time to load on some Internet connections.